The good: Incredibly interesting with a good mix of the scientific and human aspects.
The not-so-good: I might have ‘cheated’ and looked up the results of the trial because I couldn’t wait until the end.
Why I chose it: Love good medical non-fiction!
Setting: New York City
Rating: 9 out of 10
Good medical non-fiction is always hard to put down for me. Matt McCarthy’s books (he’s also written The Real Doctor Will See You Shortly, which I didn’t realise when I bought this) read like a story. This is a story of antimicrobial resistance which severely limits the lives of real people and the story of an investigator leading his first clinical trial. The two plotlines go very well together and also include the story of the people whose lives are deeply affected by chronic infections that can’t be cured by available treatments. McCarthy also goes into the history of antibiotic development and the economics of today’s drug development that limit the research for new antimicrobials. Along the way, he describes novel approaches to killing bacteria currently in development.
McCarthy is now a senior doctor specialising in infectious diseases, spending part of his time in research and the other with patients. His mentor, Thomas Walsh (who comes across as having a House-like knowledge of paediatrics, oncology and infectious diseases amongst other things, but not House’s baggage) features frequently. Tom is fascinating (someone should really write his biography) and helps to steer McCarthy during times of frustration and despair. McCarthy is leading his first trial, a pre- and post- review of the use of dalbavancin, a long acting antibiotic given as a single infusion (or a loading dose followed by a second dose some time later). He wants to help his patients with resistant skin infectious, but first there is drafting his study protocol and then having it approved. It’s not a simple process and I really sympathised with McCarthy’s frequent rewrites and answers to questions. McCarthy then meets patients for the ‘care as usual’ first part of the trial, and explains some of their stories, backgrounds and aspirations. He also describes the difficulty in finding patients that meet the multiple inclusions of the trial and separating the incentive (a gift voucher) from a true understanding of the risks and benefits. (This was a bit of an eye opener to this Australian – studies I’ve been involved in don’t offer financial incentives). McCarthy’s team then administers dalbavancin to his second cohort of patients with good results. In the meantime, there are difficult patients and trips to research labs to find out more about what steps can be taken to stay one step ahead of antibiotic resistance.
The book is easy to read, and never dull due to the patient interactions. McCarthy explains novel concepts in a simple, easy to understand way. He also details the frustrations of modern medicine in a balanced fashion, pointing out both the benefits and disadvantages of our current system.